Immediate Extubation After Aortic Valve Surgery Using High Thoracic Epidural Anesthesia: A Pilot Study
Bibliographic record
Abstract
To the Editor: Recently, several studies have presented tracheal extubation in the operating room as a routine procedure after aortocoronary bypass surgery (1–3). We conducted a pilot study that examines the feasibility of immediate extubation after simple or combined aortic valve surgery. Twenty patients undergoing aortic valve surgery with an ejection fraction of more than 30% were included in this prospective audit. After insertion of a high thoracic epidural catheter, induction of anesthesia using fentanyl 2–3 μg/kg, propofol 1–2 mg/kg, and endotracheal intubation facilitated by rocuronium, anesthesia was maintained using sevoflurane titrated according to bispectral index (target index 50). Perioperative analgesia was provided using a high thoracic epidural catheter. Patients underwent simple aortic valve surgery (n = 10) or combined aortic valve surgery (n = 10), with additional coronary artery bypass grafting (n = 6), replacement of the ascending aorta (Bentall, n = 2), repair of an open foramen ovale (n = 1), or replacement of an existing mechanical valve (n = 1). All 20 patients were extubated within 15 min after surgery at a temperature of 36.3°C (0.7) (mean (sd)). There was no need for reintubation, and pain scores were low immediately after surgery, at 6 h, 24 h, and 48 h after surgery at 1.6 (1.2), 1.4 (1.2), 1.6 (1.7), and 1.1 (1.7), respectively. In all patients, thoracic epidural analgesia was discontinued at an INR < 1.5 at 2.5 (0.6) days. Twelve of 20 patients needed temporary pacemaker activation. Immediate extubation seems feasible after aortic valve surgery using high thoracic epidural analgesia. Thomas M. Hemmerling, MD, DEAA Jean-Luc Choinière, MD, FRCPC Joanne D. Fortier, MD, FRCPC Ignatio Prieto, MD, FRCP(S) Fadi Basile, MD, FRCP(S)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".